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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Coccidioides immitis is a dimorphic fungus primarily found in the soil in a limited region of the southwestern United States. When this fungus causes an infection (coccidioidomycosis), it is due to the spores being inhaled and causing an inflammation of the respiratory tract. In most cases, the infection is self-limiting and is controlled by cell-mediated immunity. In HIV-infected patients, it is thought that the infection may be newly acquired, or reactivated, from a former incident. Patients with a CD4 count under 250 are at highest risk for becoming infected, and may present with pneumonia, fever, weight loss, night sweats, cough, and dyspnea. The infection can also become disseminated, and upon autopsy, widespread disease is found in the majority of patients that die of coccidioidomycosis. Chest x-rays show a diffuse reticulonodular infiltrate, then diagnosis is made by culturing the organism. The treatment of choice for disseminated disease is amphotericin B and alternative therapies including itraconazole and fluconazole, with possible lifelong treatment necessary. There is no current evidence that coccidioidomycosis can be prevented by any of these drugs.
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PMID:Coccidioidomycosis. 1136 25

A 46 year old Nigerian man presented with a four week history of progressive bilateral visual loss. He had been unwell, with weight loss, fever, and night sweats for six months. Dilated fundoscopy revealed macular haemorrhages and diffuse Roth's spots. The patient was found to be severely anaemic and a bone marrow aspirate revealed a T cell lymphoma with a decreased CD4+ T cell count. The patient consented for testing for HIV which proved positive.
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PMID:Roth's spots: an unusual presentation of HIV. 1295 76

Acute human immunodeficiency virus (HIV) seroconversion illness is a difficult diagnosis to make because of its nonspecific and protean manifestations. We present such a case in an adolescent. A 15-year-old boy presented with a 5-day history of fever, sore throat, vomiting, and diarrhea. The patient also reported a nonproductive cough, coryza, and fatigue. The patient's only risk factor for HIV infection was a history of unprotected intercourse with 5 girls. Physical examination was significant for fever, exudative tonsillopharyngitis, shotty cervical lymphadenopathy, and palpable purpura on both feet. Laboratory studies demonstrated lymphopenia and mild thrombocytopenia. Hemoglobin, serum creatinine, and urinalysis were normal. The following day, the patient remained febrile. Physical examination revealed oral ulcerations, conjunctivitis, and erythematous papules on the thorax; the purpura was unchanged. Serologies for hepatitis B, syphilis, HIV, and Epstein-Barr virus were negative. Bacterial cultures of blood and stool and viral cultures of throat and conjunctiva showed no pathogens. Coagulation profile and liver enzymes were normal. Within 1 week, all symptoms had resolved. The platelet count normalized. Repeat HIV serology was positive, as was HIV DNA polymerase chain reaction. Subsequent HIV viral load was 350 000, and the CD4 lymphocyte count was 351/mm3. HIV is the seventh leading cause of death among people aged 15 to 24 in the United States, and up to half of all new infections occur in adolescents. Our patient presented with many of the typical signs and symptoms of acute HIV infection: fever, fatigue, rash, pharyngitis, lymphadenopathy, oral ulcers, emesis, and diarrhea. Other symptoms commonly reported include headache, myalgias, arthralgias, aseptic meningitis, peripheral neuropathy, thrush, weight loss, night sweats, and genital ulcers. Common seroconversion laboratory findings include leukopenia, thrombocytopenia, and elevated transaminases. The suspicion of acute HIV illness should prompt virologic and serologic analysis. Initial serology is usually negative. Diagnosis therefore depends on direct detection of the virus, by assay of viral load (HIV RNA), DNA polymerase chain reaction, or p24 antigen. Both false-positive and false-negative results for these tests have been reported, further complicating early diagnosis. Pediatricians should play an active role in identifying HIV-infected patients. Our case, the first report of acute HIV illness in an adolescent, emphasizes that clinicians should consider acute HIV seroconversion in the appropriate setting. Recognition of acute HIV syndrome is especially important for improving prognosis and limiting transmission. It is imperative that we maintain a high index of suspicion as primary care physicians for adolescents who present with a viral syndrome and appropriate risk factors.
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PMID:Acute human immunodeficiency virus syndrome in an adolescent. 1452 19

Studies of HIV-related symptom and treatment side effect prevalence often fail to distinguish individual causal attributions between the two types of problems. However, an understanding of causal appraisals is critical to clarifying and intervening on coping in the context of HIV symptoms and treatment side effects. The objectives of this study are (1) to present causal attributions of symptoms reported by HIV+ adults taking combination therapy and (2) to describe the differential impact on health-related quality of life. In a cross-sectional interview study, a convenience sample of 109 HIV-positive adults taking highly active antiretroviral therapy (HAART) were interviewed using a combination of self- and interviewer-administered measures of quality of life, physical problem checklists, and side effect and HIV-related symptom attribution assessments. The most prevalent physical problems were fatigue, stiff/painful joints, aching muscles, diarrhea, feelings of depression, and neuropathy. Those most commonly labeled as side effects of HAART included upset stomach, nausea/vomiting, constipation, and changes in taste. Most commonly cited as symptoms related to HIV disease were tender lymph nodes, night sweats, weight loss, fever, and loss of strength. Impact of side effects, symptoms, and both were associated with impaired physical and social functioning. Disease-related symptoms, but not side effects, were related to perceptions of general health. Results suggest that HIV-positive persons taking HAART make distinctions between symptoms of disease and side effects of treatment. Perceived disease-related symptoms and side effects have significant and unique associations with quality of life. Findings have implications for symptom and side effects management, provider relations, and future research.
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PMID:The drugs or the disease? Causal attributions of symptoms held by HIV-positive adults on HAART. 1458 96

A 30-year-old homosexual man presented with anemia and a several months history of recurrent fever, night sweats and weakness. His travel history included several stays in mediterranean countries during the recent years. Abdominal ultrasound showed massive splenomegaly, hepatomegaly and abdominal lymphadenopathy. A bone marrow aspirate revealed the presence of numerous Leishmania amastigotes, and bone marrow culture and polymerase chain reaction were also positive for Leishmania. In this case report epidemiological, immunological, diagnostic and therapeutic aspects of HIV-Leishmania coinfection are discussed with special emphasis on the impact of liposomal amphotericin B and highly active antiretroviral therapy on the treatment of HIV-leishmania-coinfection.
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PMID:[HIV positive patient with pancytopenia and massive splenomegaly]. 1467 17

It is important to exclude tuberculosis prior to preventive therapy, but this can be difficult in patients with symptomatic human immunodeficiency virus (HIV) disease. Patients with clinically advanced HIV disease were screened for active tuberculosis using a symptom questionnaire, measured weight loss, chest radiography, sputum microscopy and culture prior to receiving tuberculosis preventive therapy. Tuberculosis was diagnosed in 11 of 129 patients screened. A simple screening instrument of two or more of the symptoms measured weight loss, cough, night sweats or fever, had a sensitivity of 100% and specificity of 88.1%, and positive and negative predictive values of 44% and 100%, respectively.
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PMID:Screening for tuberculosis in adults with advanced HIV infection prior to preventive therapy. 1518 52

PRESENTING FEATURES: An 18-year-old white man was admitted to the Osler Medical Service with the chief complaint of back pain. Two weeks prior to admission, the patient developed diffuse and aching upper back pain. Over the next couple of days, he also developed severe anterior chest pain that was somewhat pleuritic in nature but diffuse and extending bilaterally into the shoulders. One week prior to admission, he developed intermittent fevers and night sweats. The patient denied any lymphadenopathy, pharyngitis, sick contacts, shortness of breath, rash, or bleeding. He was seen by a physician and told that he had thrombocytopenia. There was no history of recent or remote unusual bleeding episodes. His medical history was unremarkable except for a childhood diagnosis of attention deficit/hyperactivity disorder. He was not taking any medications and had no history of tobacco, alcohol, or illicit drug use. He had no risk factors for human immunodeficiency virus infection. Physical examination showed that he was afebrile and had normal vital signs. He was a well-appearing man who was lying still because of pain. HEENT examination was unremarkable. There was no pharyngeal erythema or exudates. His lungs were clear. His neck was supple and without lymphadenopathy. Examination of his back and chest revealed no focal tenderness. There was no hepatosplenomegaly, and his skin was without petechiae or rashes. Examination of the patient's joints showed pain on passive and active movement of his shoulders bilaterally, but no frank arthritis. There was no rash, petechiae, or echymoses. Chest radiograph and electrocardiogram were unremarkable. On admission, the laboratory examination was notable for a hematocrit level of 32.5%, with a mean corpuscular volume of 79 fL, and white blood cell count of 2.8 x 10(3)/microL. Platelet count was 75 x 10(3)/microL. A white blood cell differential revealed 7% bands, 53% polys, 34% lymphs, 5% atypical lymphocytes, 2% nucleated red cells, and a few young unidentified cells. His chemistry studies were unremarkable. What is the diagnosis?
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PMID:Cases from the Osler Medical Service at Johns Hopkins University. 1521 Mar 89

Tuberculosis (TB) is one of the oldest known diseases and has claimed more lives than any other Today, about one-third of the world's population is infected with TB. In 2003, 1,379 cases of new, active and relapsed TB were reported in Canada. TB is caused by Mycobacterium tuberculosis. Only 10 per cent of infected individuals will develop active TB. Pulmonary TB can be spread by an infectious person through the aerosolization of droplets when coughing, talking, spitting, sneezing or singing. Symptoms of pulmonary TB are a cough with or without sputum production lasting at least three weeks, chest pain, hemoptysis, fever, night sweats, weight loss, lack of appetite, chills and weakness. Extrapulmonary TB is generally not associated with person-to-person spread. Common sites include the throat, lymph nodes, abdomen, intestines, long bones of the legs, spine, kidneys, bladder, skin, eyes and meninges. The risk factors for TB infection and disease include close contact with an active pulmonary TB case, HIV infection or AIDS, inactive disease not adequately treated, low income, underlying medical condition, homelessness, alcoholism, injection drug use, aboriginal background or occupation in health care. Risk settings include travel or residence in an endemic area or work or residence in a correctional facility, shelter, rooming house, residential facility, hospital or long-term care facility. Nurses need to advocate for the prompt diagnosis and isolation of suspected and confirmed TB cases. Knowing when to institute such measures as isolation in a negative pressure room, using respirator masks and limiting interpersonal contacts is vital to the nursing care of TB patients. In addition, the role of the public health department needs to be understood; for example, all jurisdictions have legislated requirements for reporting new positive TB skin tests to public health.
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PMID:Tuberculosis prevention and treatment. 1562 10

Tuberculosis (TB) is often mistaken for community-acquired pneumonia (CAP). To avoid missing the diagnosis, we recommend that any CAP patient with upper lobe infiltrate, cavitation, miliary pattern, hemoptysis or >1 month of any of cough, fever, malaise,weakness, night sweats, or significant weight loss, should have sputa submitted for Mycobacterium tuberculosis smear and culture. Any CAP patient failing or relapsing after empiric therapy should be investigated for TB. In the presence of HIV with low CD4 count (< or = 200 cells/mL), the presentation may be atypical, and therefore sputa should be submitted for M tuberculosis. Any HIV patient, regardless of CD4 count, with a known history of positive tuberculin skin test, previous TB, or recent exposure to TB, who presents with CAP, should be investigated for TB.
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PMID:Tuberculosis: still overlooked as a cause of community-acquired pneumonia--how not to miss it. 1576 19

Intestinal tuberculosis is a major problem in many regions of the world. The incidence of it is rising in Western countries due to immigration from Third World countries and human immunodeficiency virus infection. The difference between the simple closure and resection and anastomosis was evaluated in this study. Retrospectively, 12 patients with intestinal tuberculosis diagnosed histopathologically among 50 patients with free intestinal perforations operated on between 1995 and 2003 at Turgut Ozal Medical Center were evaluated. Each patient underwent routine laboratory tests and radiologic studies. The most common symptoms of patients were abdominal pain, night sweats, and weight loss. Sites of perforation were ileum in 10 patients (multiple perforation in 4) and jejunum in 2 patients (both had multiple perforations). The perforation was closed by primary closure in 7 patients. Resection-anastomosis was performed in 5 patients. Leaks occurred in overall 3 of 7 patients with primary closure. Three of the 7 patients with leaks due to septicemia died. The mortality rate among all patients was 25%. Intestinal tuberculosis should be kept in mind as a cause in free intestinal perforations. Because of high mortality rate, the resection of the affected area and anastomosis may be the treatment of choice rather than primary closure.
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PMID:Spontaneous small bowel perforations due to intestinal tuberculosis should not be repaired by simple closure. 1579 33


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